Obesity & Weight Management Final Exam

What were the USPSTF guidelines for adults with regard to the most effective behavioral counseling intervention?

Weight Loss Goals = 5% of TBW
– Moderate Intensity = 12-24 weeks with ≥12 sessions in the first
year; include a core, support and maintenance phase
– Multicomponent delivery = group, individual, mixed,
technology-based, and print-based
• The most effective characteristics, such as the number of sessions,
whether they are in-person vs. remote, or group vs individual-based
may depend on tailoring interventions to social, environmental, and
individual factors
– Target Multiple Behaviors = improving nutrition, increasing
physical activity, (stress management!!)
– Interventionists = highly diverse including behavioral therapists,
psychologists, registered dietitians, exercise physiologists,
lifestyle coaches

– Tools to support weight loss or weight loss
maintenance (example: pedometers, food scales, or
exercise videos)
– Skills to support weight loss or weight loss
maintenance (self-monitoring of weight and dietary
intake, goal-setting, identify barriers/problem-solving,
peer support, and relapse prevention)
• Best practice example: The Diabetes Prevention
Program- Lifestyle Intervention

What are the steps to the 5 A’s Model?

Assess, advise, agree, assist, arrange

With regard to healthy eating, what are the 4 main goals recommended by the IOM?

1. promote consumption of nutritious foods & encourage breast feeding during infancy
2. help adults increase physical activity & decrease sedentary behavior in young children
3. help adults increase children's healthy eating
4. Create a healthful eating environment that is responsive to children's hunger and fullness cues.

What type of risk assessment, screening tests and interventions does the US Preventative Services Task Force recommend for children and adolescents 6 years of age and older?

Risk assessment: parental obesity, poor nutrition, low physical activity, inadequate sleep, sedentary behavior, and low family income

Screening tests: BMI, age specific and sex specific for 95th percentile or greater

Interventions: comprehensive and intensive behavioral interventions

What factors do you measure when assessing self-efficacy?

- Have they ever had successful or unsuccessful attempts at weight management? What factors were involved in previous attempts?
- How do family, friends, and co-workers influence their choices? Motivation?
- Do they have readily available resources for weight management therapy? (time & cost)

What psychological factors effect motivation?

• Internal locus of control
– A person’s perception that personal outcomes are
determined by personal actions
– Reflects autonomy and competence
– People who have an internal locus of control are
• more resilient
• display better self-control and emotional self-regulation
• tend to have higher self-efficacy
• are more intrinsically motivated

 

• External locus of control
– A person’s perception that personal outcomes are
determined by other people’s actions, external
circumstances, or chance.
– Reflects relatedness
– People with an external locus of control are
• less resilient
• display less self-control and emotional self-regulation
• tend to have a lower self-efficacy
• are more extrinsically motivated

Based on the information in each of the slides with this title, how do you enhance motivation to enhance success? (Implies you understand the types of motivation discussed, how motivation impacts the value of change and how to leverage that)

·      • Intrinsic Motivation- motivation that
comes from personal factors

 •Extrinsic Motivation: motivation that comes
from environmental factors

• Outcome Expectations
– When an individual places high value on a given
outcome or end result.
– If expectations are highly valued, then motivation will
increase once the outcome is achieved.
• Which type of motivation favors outcome expectations?
• Outcome Expectancies
– When an individual places high value on performing a
given behavior regardless of the outcome or end
result.
– If expectancies are highly valued, then motivation will
be high throughout the process of change
• Which type of motivation favors outcome expectancies?

To leverage outcome expectations, set
small, achievable weight management
goals
– How do you eat an elephant?
• Target a behavior the patient is highly motivated to change
• set realistic goal(s) 1 behavior at a time
• Monitor progress and assist patients in:
– overcoming challenges whenever they arise
– connecting their successes to enhancing their core values
• “Those with more modest absolute weight loss
goals were more likely to achieve their goals and
more likely to maintain weight loss 2.5 years after
starting a program.” (Teixeira, et. al., 2004)

• To leverage outcome expectancies,
help the patient connect the positive
outcomes of the behavior itself to their
core values as often as possible:
– Prevention/management of co-morbidities
– Enhanced quality of life
– Higher self-esteem/self-value/emotional health
– More self-awareness, self-control and self-
efficacy

How do mindfulness-based interventions impact eating behaviors?

Improvement in binge eating frequency and/or severity, emotional eating/external eating (response to external trigger, smell, sight, taste)

What are the Assist Step Problem-Solving techniques and what do they consist of?

The Assist Step Problem-Solving technique:
consists of identifying the barriers the patient is
experiencing in achieving each of their behavioral
goals and developing a plan with clear strategies
to overcome these barriers.

A- Attitude- Normalizing patient’s attitude

D- Define- Define or identify the problem

A- Alternative solutions- Generate alternative solutions and set a goal around the selected solution

P- Predicting consequences- Predicting consequences of each proposed solution and deciding which solution is most appropriate

T- Trying out solution- Try out solution and evaluate effectiveness

Based on the behavior change case study discussion in class, be able to recognize the use of the following behavior modification techniques: contingency management, cognitive rehearsal

Contingency management: behavior is a function of its consequences; cognitive, verbal and/or tangible consequence are used to promote support behavior and repel negative behavior; positive consequences= repeat action

Cognitive rehearsal: to consciously rehearse ones thoughts and visualize making healthy behavioral choices, surrounding a potentially difficult situation prior to experiencing it, so they will be armed with those healthy, adaptive respondes when that experience actually occurs

What did WOTN say it takes to lose weight? Know the 5 steps and the 6^th added from class materials

1.     Start with small steps

2.     Make realistic goals

3.     Seek support

4.     Keep portions under control

5.     Track your caloric intake

6.     Strategies based on diet restriction alone are overwhelmingly ineffective and potentially physiologically and psychologically

According the Dietary Guidelines for Americans, what are the top 2 sources of sugar in the American diet?

Beverages and desserts/snacks

What is the problem with "filling up" on beverages?

Waste of calories, not sustainable, hungry sooner, no nutritional value

With regard to choosing nutrient dense foods, what are the tips for success?

Unrefined whole grains, veggies and fruit, fiber rich foods, look for more than 7g of protein per serving, unsat fat, more than 5 g of fiber, vitamin, minerals. make plate ½ full of veggies/fruit, chose whole grains and seeds high in fiber, don’t drop below recommended caloric intake, consistent meal pattern

How can we help patients to increase their access to nutrient dense foods?

Start your own garden, rethink food bank & free community meal

Article: Meal Frequency and Weight Loss: does decreasing meal frequency increase metabolism? Is it better for weight loss? Why or why not?

No, it doesn’t affect metabolism, not better for weight loss because you feel hungrier then you actually are at the time of meal

Article: intermittent fasting: what is the benefit of intermittent fasting?

Resist disease because cells are under mild stress during fasting phase, lipolysis shown to protect memory and learning functionality and slow disease process in brain, overall reduces caloric intake

Be able to list 1 tip to avoid extreme hunger and 1 tip regarding things to do instead of eat.

1 tip to avoid extreme hunger: eat breakfast every day

1 tip regarding things to do instead of eating: go for a walk

What are the determinants of a child’s eating behaviors?

Family and Peer influences
– Modeling- food preferences, portion sizes
• Family Influences
– feeding style
– mealtime structure
– parent attitudes and behaviors
• Environmental Influences
– food availability- type and quantity
– Food accessibility- ease of access
• Socioeconomic influences
• knowledge, accessibility,
• Cultural influences
• acceptability

How does the Table Time Model for meal-time structure and feeding communication promote healthier eating patterns among children? (know and be able to recognize these variables: The FIT intervention model, authoritative feeding style)

meal time structure
- "FIT" intervention model
- parent is responsible for what foods are served family style (provide array of healthful foods) and the atmosphere of the meal
- child decides what / how much to eat, independently assessing if they feel hungry
- teaches children how to detect satisfaction cues & offers parents practice exposing their child to healthy food options while using the authoritarian feeding style

feeding style
- promote use of authoritative style
- develop parent education classes that focus on reasons and rationales for why children should eat more fruits and vegetables
- allows parents to become better role models

Which is more important: losing weight or being fit?

Being fit and having a good diet is more important. You need to be active rather than being sedentary and thin.

Can an Individual be Healthy at Every Size?

Yes, it is more about the athletic level and diet

Must we choose between PA and academic achievement?

PA on brain function showing that aerobic activity improves cognition and performance

·     

What did Steven Blair mean when he stated in his article, “In essence, physical activity is the common denominator for the clinical treatment of low fitness and excess weight, making the “fitness vs fatness” debate largely academic”? (worth 5 points) What did he say we should be focused on? (worth 5 points)

He emphasized that physical activity improves fitness and helps with weight management, so arguing over which factor—fitness or fatness—is more important is less productive than focusing on the shared intervention that benefits both.

Blair said that instead of debating fitness versus fatness, we should focus on getting sedentary individuals to become more physically active. This shift in focus would bring significant health and financial benefits, both individually and societally. He called on physicians, researchers, and policymakers to promote physical activity as a core component of both clinical therapy and public health policy.

How does the new approach from the ACSM define an individual who is “active?”

Planned, structured PA for at least 30 min 3 times a week at moderate intensity

Based on the PA Assessment Case Study, and the new ACSM guidelines for assessing the presence or absence of known cardiovascular, metabolic or renal disease, and signs and /or symptoms suggestive of these diseases, be able to determine whether an individual is considered active, or inactive and whether or not they need medical clearance before participating in a structured exercise program or not. Finally, if that individual does not need medical clearance, or has obtained medical clearance from their doctor, be able to determine the appropriate starting intensity level for cardiorespiratory fitness training. Be able to write that intensity based on HRR/VO₂R.

Light-intensity exercise; 30-40% HRR or VO2r. moderate-intensity exercise 40-60% HRR/VO2r

What is the difference between a direct measure of PA and an indirect measure of PA? Be able to recognize or give examples of both.

Direct measure of PA= aims to provide a detailed account of habitual daily PA and their associated duration and intensity (pedometer, motion sensors, fitness tracing watch, hr monitors).

Indirect PA= used to acquire substitute measures of PA, estimates of PWC and EE based on fitness levels (durable treadmill)

What are the advantages to using indirect measures of physical activity?

Provides an objective, reproducible estimate of recent PA, can verify positive changes in CRF as a result of PA participation over time, CRF levels are directly acquired from PA participation

Know the type of CRF exercises that would be most appropriate for people who carry extra weight and upon what those choices with depend

beginners= pool walking; intermediate= brisk walking or inline walk; advanced= incline outdoor hiking, outdoor jogging

What is the benefit of using interval training for CRF with people who carry extra weight?

Performed for same length of time, caloric expenditure is higher than with constant intensity training, results in higher CR fitness levels

Based on our PA Case Study discussion, and the physical activity and obesity PowerPoint presentation: Know the ACSM guidelines regarding frequency, intensity, time, and the general recommendations for type, for creating both a resistance training and a flexibility training program. Be able to apply ACSM’s guidelines using the FITT prescription to create a resistance training program for a novice exerciser wanting to improve strength, and a flexibility training program for an adult.

• Frequency: how many times per week
• Intensity: imposed demand or overload
– CRF exercise = % of THR OR % of VO2max
– Muscular strength or endurance = % of 1RM
• Time: length of each exercise session
– CRF exercise = time/distance
– Muscular strength or endurance = # of exercises & reps/sets
• Type: specific modality for desired outcome
– CRF exercise: activities that require repetitive movements of large
muscle groups
– Muscular strength and endurance: exercises that target all major
muscle groups to promote an increase in capacity
– Muscular flexibility: exercises that target all major muscle groups
to promote a safe increase in ROM

 

flexibility; 1-2 days/wk, i-stretch each tendon to point of tightness for 10-30seconds, t-hold each stretch for 10-30 seconds, t-a series of flexibility exercises for each of the major muscle tendon units. RT: 1-2 days/wk, i-60-70% of 1 rm, t-8 to 12 rps per set, t-medium bands, weight machines, ball and free weight

What is the benefit of using circuit resistance training with people who carry extra weight?

Maximizes caloric expenditure while simultaneously increasing CR and muscular endurance

Based on behavior therapy techniques and our discussion on cognitive restructuring, how would you respond to the client statements given on slide #2?

See if they can curve out time out of day, limit screen time, incorporate exercise while at work, break up time into intervals, educate on what fitness is

What are some ways clients can leverage social support? Be able to recognize examples of social support.

• Spouse
- Holding off on dinner for an hour
- Watching the kids while the other spouse exercises
• _______________________________________
• Friend
- PA partner
- Encouragement
• _______________
• Family
- Family PA activities instead of family TV viewing. Examples?
• Community
- Participate in community PA events and programs

What are the benefits of school-based PA?

Education in PA, better focus in school, learn how to make fitness enjoyable, break, happier, reduce stress

What is the goal of the Whole Physical Education (PE) and Physical Activity (PA) component of the Whole School, Whole Community, Whole Child (WSCC) Model? What components does it include?

WSCC includes: pe and pa, nutrition environment and servic3s, health education, social and emotional climate, physical environment, health services, counseling and social services, employee wellness, community wellness, family engagement. goal of pe and pa; the opportunity for students to be physically active throughout the day through the whole child model

Based on the video excerpts viewed in class, and our class discussion, are the use of commercial diets or weight loss programs considered significantly effective or sustainable? Why or Why not?

Considered effective because the diets work because of calorie deficit

What are the 4 methods members of the national weight control registry reported using to keep off the weight they lost?

1. 78% eat breakfast everyday
2. 75% weigh themselves at least once per week
3. 62% watch less than 10 hours of TV per week
4. 90% exercise, on average, about 1 hour per day

What is the rationale for drug therapy?

Obesity is a chronic disease, biochemistry of obese individuals is different of lean people, when obese ppl loses weight, their biochemistry doesn’t change so they need long-term pharmacological support to maintain weight loss

What are the strategies to maximize the benefits of weight loss medications?

Establish if patients are an appropriate candidate, set reasonable weight loss goal, implement non-med treatment therapies in conjunction with meds, choose meds based on patient’s medical history/needs, risk/behalf ratio

What are the hurdles in the obesity treatment landscape?

Gaining sufficient buy-in from government agencies, employers, and insurers, accepting that some patients may need to take medications long-term, doctors prescribing medications appropriately

What are the NHLBI Guidelines for drug therapy to be approved for use with a patient?

• For individuals with a BMI ≥30, or BMI ≥27 with at least 1 obesity-
  associated comorbid condition (EOSS stage 2 and higher), who are
  motivated to lose weight, pharmacotherapy can be considered as
  an adjunct to comprehensive lifestyle intervention to help achieve
  targeted weight loss and health goals.

• Medications should be FDA-approved for weight loss, and
  prescribing clinicians should become knowledgeable about the
  product.

• The provider should weigh the potential risks of the medication
  being considered against the potential benefits of successful weight
  loss for the individual patient.